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It seems that every deadline and compliance date for health I.T. leaders is just around the corner. And unfortunately, they are, including the start of the Stage 2 EHR meaningful use program. The beginning of the 2014 federal fiscal year (in October 2013) is when hospitals need to have their ducks in a row to apply for Stage 2 payments. The application period for physicians and other eligible professionals opens January 2014 (for more on attestation and reporting periods, see sidebar, page 32).

Mind you, those are the earliest dates when hospitals and EPs can apply. But many feel an urgent need to get meaningful use Stage 2 done so they can tackle the other pressing items on their plate, such as ICD-10 compliance work, as well as multiple components of the health reform law such as new care and reimbursement processes. As Bill Spooner, senior vice president and chief information officer at eight-hospital Sharp HealthCare in San Diego explains it, ICD-10 is in October 2014, state insurance exchanges are in January 2014, Stage 2 is in fiscal 2014, "and we also have to take care of our patients."

Providers that struggled with Stage 1 won't have an easier time with the second stage, as the bar for compliance is raised. In particular, two meaningful use measures in Stage 2 could be very troublesome for providers to comply with, HIT leaders say.

The final Stage 2 rules require that patients have the ability to view, download or transmit their health information within four business days of the information being available to an eligible professional, and within 36 hours of a hospital discharge, AND then getting at least 5 percent of patients to actually use the service.

Eligible professionals have another hurdle, as they must use secure messaging technology to communicate with at least 5 percent of patients on relevant heath information.

Having the technology for view/download/transmit won't be difficult for providers under Stage 2, since patient portal products are readily available, says David Borden, chief technology officer at MRO Corp., a vendor of release of information technology and services.

There will be process changes and workflow challenges associated with adopting the portals, but the real heavy lifting will be in getting the required threshold of patients to participate. "For the first time, meaningful use attestation will depend not just on what the provider does, but in changing patient behavior," Borden adds.

Consequently, some providers are in a hurry-up mode to get a handle on how they will obtain proof of a certain level of patient engagement. At Greater Baltimore Medical Center, initial meetings on implementation of a patient Web portal started in October 2012 with Jeanne Day, director of health information management, and David Hynson, CIO, leading the project and working with the hospital's meaningful use governance committee.

The initial plan calls for completion this month of a charter document outlining the purpose of the project, key stakeholders and participating personnel within the hospital, selection of a patient portal vendor by the end of February 2013, and portal implementation starting in July when the hospital's new fiscal year-which includes portal funding-begins. The hospital is not yet considering process and workflow changes that the portal will require, believing it will better understand what changes are needed as they learn of various portal functions during the vendor selection process, Day says.

A patient portal is a must-have to comply with view/download/transmit, and it also could help with secure messaging as well, Spooner says. He envisions discharge coordinators, admissions staff and nurses will handle patient education in the hospitals with front desk personnel and nurses doing the same in ambulatory settings, although that might vary based on the practices.

But his message on the timetable to get ready is clear: "You need to be thinking of it now and you don't have a lot of time. There are a lot of moving parts and it does overlay with ICD-10 and everything else, so don't delay."

There's another timetable factor associated with meaningful use as time periods for Stage 2 were changed in the final rules and trying to figure out the best time to attest may be confusing.

In Joe Goedert’s feature story in the December issue of Health Data Management, providers size up these challenges, how they expect to tackle them, and what they don’t yet know.